Robertson Michael, Morris Kirsty, Walter Garry
Royal Prince Alfred Hospital and Sydney South West Area Health Service (Eastern Sector), NSW, Australia.
Australas Psychiatry. 2007 Oct;15(5):402-10. doi: 10.1080/10398560701439640.
The aim of this paper is to describe the ethical theories of utilitarianism and the ethics of duty (Kant's ethics) and to evaluate their value as theoretical bases of psychiatric ethics.
Utilitarianism is a well-established moral philosophy and has significant instrumental value in dealing with common ethical problems faced by psychiatrists. Despite its capacity to generate solutions to ethical problems, utilitarianism requires a process of what Rawls described as 'reflective equilibrium' to avoid morally repugnant choices, based on utility. The criticisms of utilitarianism, such as the problems of quantifying utility and the responsibility for consequences, are very relevant for psychiatry. Singer's model of utilitarian thinking is particularly problematic for our profession. Kant's ethics provides the pretext for duty bound codes of ethics for psychiatrists, but suffers from problems of flawed claims to the universalizability prescribed by Kant's 'categorical imperative'. Kant's valorization of reason as the core of the autonomy of persons is a valuable insight in understanding psychiatrists' ethical obligations to their patients.
本文旨在阐述功利主义伦理理论及义务伦理学（康德伦理学），并评估它们作为精神科伦理学理论基础的价值。
功利主义是一种成熟的道德哲学，在处理精神科医生面临的常见伦理问题方面具有重要的工具性价值。尽管功利主义有能力生成伦理问题的解决方案，但它需要一个罗尔斯所描述的“反思平衡”过程，以避免基于功利做出道德上令人厌恶的选择。对功利主义的批评，如功利量化问题和对后果的责任问题，与精神病学密切相关。辛格的功利主义思维模式对我们这个职业来说尤其成问题。康德伦理学为精神科医生的义务性伦理准则提供了依据，但存在康德“绝对命令”所规定的普遍izability存在缺陷的问题。康德将理性视为个人自主性的核心，这在理解精神科医生对患者的伦理义务方面是一个有价值的见解。
